高原骨折病人用酥油预防褥疮的护理体会

目的探讨骨折病人用酥油预防褥疮的效果。方法对120例高原骨折患者采用酥油涂摩并作相应护理。观察防护骨折卧床病人压疮效果。结果除2例是入院前褥疮即存在外,未见入院后褥疮发生。结论用酥油预防褥疮的护理措施在高原寒冷地区是切实可行的,效果肯定。     

布惊仁垫联合安普贴在预防压疮中的应用

目的:探讨布惊仁垫联合安普贴对长期卧床患者压疮的预防效果.方法:将新入院患者进行压疮风险评估后随机分为两组,对照组采用水垫,观察组使用布惊仁垫联合安普贴进行护理观察受压部位皮肤的变化.结果:25例患者预防性使用布惊仁垫及安普贴,无1例发出压疮.结论:使用布惊仁垫联合安普贴预防压疮效果显著.     

长期卧床病人鼻饲反流误吸的预防及护理

目的：预防或减少长期卧床病人鼻饲管进食患者吸入性肺炎的发生,探讨改进鼻饲法的效果。方法：架顾分析本院选择的86例鼻饲患者,分析吸入性肺炎的发生情况。结果：通过采集各种有效的护理措施,降低并发症的发生,促进患者顺利恢复健康,无病人因并发症而死亡。结论：正确的鼻饲方法、细致的观察、良好的体位护理,效减少反流误吸的发生,提高病人生活质量,降低治疗费用,降低病死率。     

自制水枕在重型颅脑损伤中的临床应用

目的观察使用自制水枕对重型颅脑损伤患者头部压疮的预防作用。方法将60例符合入选标准的重型颅脑损伤患者随机分为治疗组和对照组,每组均30例,治疗组常规使用自制水枕预防头部压疮,并按相关指标观察。结果两组年龄分布、性别构成比较差异无统计学意义（P〉0.05）;经观察统计治疗组使用自制水枕后,无一例头部压疮发生,对照组发生头部压疮3例,两组头部压疮发生率比较差异有统计学意义。结论使用自制水枕能有效预防重型颅脑损伤患者头部压疮的发生,使用方便,安全有效,值得临床运用和推广。     

腹膜后腹腔镜下肾囊肿去顶减压术66例护理体会

目的:探讨经腹膜后腹腔镜下肾囊肿去顶减压术的护理方法.方法:对66例行经腹膜后腹腔镜下肾囊肿去顶减压术的患者,术前予以心理护理、术前指导,术后密切观察生命体征,做好引流管的护理及并发症的观察护理.结果:66例患者均一次手术治愈出院,随访3个月至1年,无复发.结论:经腹膜后腹腔镜下肾囊肿去顶减压术疗效较好,安全,科学规范的护理有效促进患者康复.     

高龄患者髋关节置换术后护理体会

老年人股骨颈骨折，人工髋关节置换术为一种公认的有效治疗方法，我院1999年6月至2005年4月实施人工髋关节置换治疗老年股骨颈骨折病人93例，针对骨折病人长期卧床、恢复缓慢、易出现并发症等特点，通过护理人员手术前后有计划的护理，加强病人对基本知识的了解，积极配合治疗，有效地预防并发症的发生，取得良好的效果，现将其护理体会介绍如下。     

卧床患者功能性便秘的生物反馈治疗及有效护理探讨

目的探讨卧床患者功能性便秘的生物反馈治疗及护理的临床效果。方法利用震动排痰机的叩击和震动原理缓解与治疗卧床病人功能性便秘。选取慢性支气管炎急性发作卧床72小时以上患者130例进行分组护理,并对照分析。试验组：常规护理加叩击震动;对照组：常规护理加腹部按摩。结果试验组的排便效果明显改善,且有显著性差异。结论利用震动排痰机的叩击和震动原理来缓解与治疗卧床病人功能性便秘,可为临床实施生物反馈治疗及有效护理提供新的思路。     

骨科卧床病人便秘的护理干预效果观察

目的观察护理干预对骨科卧床病人便秘的效果。方法将80例住院患者随机分为观察组与对照组各40例,对照组采用常规护理,观察组在此基础上加用按摩、饮食调理、心理护理等方式。结果、观察组经过综合护理干预后发生便秘5例,对照组发生便秘27例,观察组疗效优于对照组（P〈0.01）。结论适当的护理干预可减少便秘的发生。     

甲状腺手术并发症的预防及术后护理

目的探讨甲状腺手术并发症的预防及术后护理。方法对180例甲状腺手术后并发症的预防和护理结合相关文献进行分析。结果180例甲状腺手术病例均痊愈出院，只有2例并发症发生。结论做好充分术前准备、术后密切观察病情及做好精心护理是可以有效的降低并发症，促进病人早日康复。     

经尿道前列腺电切术术后出血原因与护理对策

目的：探讨经尿道前列腺电切（TURP）术后出血的原因、预防及护理措施。方法：回顾分析经尿道前列腺电切病人术后出血临床资料,总结出血的原因及护理。结果：对30例病人出血的观察和及时有效的护理措施,均满意止血。结论：通过不同阶段出血原因分析及早期观察处理,保持正确的体位,保持冲洗及导尿管通畅,防止腹内压增高,预防感染是减少出血有效的方法。     

Comparative evaluation of the tendon-bone interface contact pressure in different single- versus double-row suture anchor repair techniques

The aim of the study was to evaluate the time zero contact pressure over a defined rotator cuff footprint using different repair and stitch techniques in an established sheep model. Forty fresh-frozen sheep shoulders were randomly assigned to five repair groups: single-row repair using simple stitches (SRA-s), single-row repair using horizontal mattress stitches (SRA-m), and single-row repair using arthroscopic Mason-Allen stitches (SRA-ama). Double-row repair was either performed with a combination of simple and horizontal mattress stitches (DRA-sm) or with arthroscopic Mason-Allen/horizontal mattress stitches (DRA-amam). Investigations were performed using a pressure-sensitive film system. The average contact pressure and pressure pattern were measured for each group. Contact pressure was lowest in SRA-m followed by SRA-s. SRA-ama showed highest contact pressure of all single-row treatment groups (P < 0.05). DRA-amam presented the highest overall contact pressure (P < 0.05), whereas DRA-sm exerted contact pressure equal to that of SRA-ama. Both double-row techniques showed the most expanded pressure pattern. Average contact pressures for the more complex single- and double-row techniques utilizing arthroscopic Mason-Allen stitches were greater than were those of the repair techniques utilizing simple and horizontal mattress stitches. However, the contact pattern between the anchors could be increased by using the double-row technique, resulting in more footprint coverage compared to patterns utilizing the single-row techniques. These results support the use of the more complex arthroscopic Mason-Allen stitches and may improve the environment for healing of the repaired rotator cuff tendon.     

Reproducibility of Patient Positioning for Fractionated Extracranial Stereotactic Radiotherapy Using a Double-Vacuum Technique

BACKGROUND AND PURPOSE: Precise reproducible patient positioning is a prerequisite for conformal fractionated radiotherapy. A fixation system based on double-vacuum technology is presented which can be used for conventional as well as hypofractionated stereotactic extracranial radiotherapy. MATERIAL AND METHODS: To form the actual vacuum mattress, the patient is pressed into the mattress with a vacuum foil which can also be used for daily repositioning and fixation. A stereotactic frame can be positioned over the region of interest on an indexed base plate. Repositioning accuracy was determined by comparing daily, pretreatment, orthogonal portal images to the respective digitally reconstructed radiographs (DRRs) in ten patients with abdominal and pelvic lesions receiving extracranial fractionated (stereotactic) radiotherapy. The three-dimensional (3-D) vectors and 95% confidence intervals (CI) were calculated from the respective deviations in the three axes. Time required for initial mold production and daily repositioning was also determined. RESULTS: The mean 3-D repositioning error (187 fractions) was 2.5 +/- 1.1 mm. The largest single deviation (10 mm) was observed in a patient treated in prone position. Mold production took an average of 15 min (10-30 min). Repositioning times are not necessarily longer than using no positioning aid at all. CONCLUSION: The presented fixation system allows reliable, flexible and efficient patient positioning for extracranial stereotactic radiotherapy.     

Biomechanical comparison of traditional and locked suture configurations for arthroscopic repairs of the rotator cuff

BACKGROUND: The optimal suture configuration for arthroscopic rotator cuff repairs is controversial. "Locked" suture configurations, which use a combination of simple and transverse suture loops, have demonstrated better fixation strength than have traditional simple and horizontal mattress techniques. PURPOSE: To compare traditional arthroscopic suture configurations to locked arthroscopic configurations in ability to resist gap formation under cyclic loading. STUDY DESIGN: Controlled laboratory study. METHODS: Crescent-shaped defects were created at the infraspinatus tendon insertion in 32 bovine shoulders. Four arthroscopic suture configurations were tested (8 specimens in each group): simple (group 1), horizontal mattress (group 2), locked mattress (group 3), and locked inverted mattress (group 4). A metal corkscrew suture anchor doubly loaded with No. 2 Fiberwire suture was used for the repairs. A cyclic loading protocol with application of forces from 10 to 180 N for a maximum of 2,500 cycles was used. The number of cycles required to form gaps of 5 mm and 10 mm was recorded. RESULTS: The locked mattress configuration (group 3) outperformed all other groups in resisting 5-mm gap formation (P < .0001), requiring a mean of 628 cycles in comparison to 65, 193, and 197 cycles for groups 1, 2, and 4, respectively. Both locked configurations (groups 3 and 4) were superior to traditional simple and horizontal mattress configurations in resisting 10-mm gap formation. CONCLUSION: The locked mattress suturing technique (group 3) provided the most secure tendon fixation of all arthroscopic configurations tested. CLINICAL RELEVANCE: The use of locked suture configurations for arthroscopic rotator cuff repairs may enhance tendon fixation and limit gap formation in the early postoperative period.     

Skin interface pressure on the NATO litter

The NATO litter serves as a transport device and hospital bed during all types of operations. Little is known about the skin interface pressure on this litter. The purpose of this study was to determine whether various types of padding on the litter and body position affect the peak skin interface pressure and the total body area exposed to interface pressures above 30 mm Hg at different body areas. Thirty-two subjects participated. A repeated measures design was used. The surface effect was statistically significant for all peak pressure and surface area analyses (repeated-measures analysis of variance, p < 0.01). There was a significant decrease in peak pressure and surface area between the litter and litter plus aeromedical evacuation mattress. The addition of the blanket did not significantly reduce pressures and should not be considered a pressure-reducing measure. Conversely, an aeromedical evacuation mattress should be used for all high-risk patients if feasible. Preventive measures (turning, elevating the heels) are still required.     

Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques

BACKGROUND: Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface pressure of the rotator cuff tendon to the greater tuberosity for different rotator cuff repair techniques. HYPOTHESIS: The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint than do suture anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Simulated rotator cuff tears over a 1 x 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n = 8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined using pressure-sensitive film placed between the tendon and the tuberosity. RESULTS: The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous technique (67.7 +/- 5.8 mm(2)) compared with the suture anchor simple (34.1 +/- 9.4 mm(2)) and suture anchor mattress (26.0 +/- 5.3 mm(2)) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique (0.32 +/- 0.05 MPa) compared with the suture anchor simple (0.26 +/- 0.04 MPa) and suture anchor mattress (0.24 +/- 0.02 MPa) techniques (P < .05). CONCLUSION: The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution over a defined footprint when compared with suture anchor techniques. CLINICAL RELEVANCE: Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in the development of improved open and arthroscopic rotator cuff repair techniques.     

Automatic tube current modulation for whole-body polytrauma CT with immobilization devices: is there an increase in radiation dose and degradation of image quality?

The objective of this study was the assessment of the image quality and radiation dose in polytrauma CT using immobilization devices. An anthropomorphic whole body and a liver phantom were scanned on a 128-slice CT scanner with four different protocols using automatic tube current modulation (120 kVp, 150 ref. mAs; 120 kV, 200 ref. mAs; 140 kVp, 150 ref. mAs; and 140 kVp, 200 ref. mAs) and four different setups (no immobilization device (setup A), vacuum mattress 1 (setup B), vacuum mattress 2 (setup C), and spineboard (setup D)). Qualitative and quantitative image quality parameters and radiation dose were assessed. Image noise increased on average by 6.6, 11.2, and 9.4 %, and CNR decreased by 11.2, 13.9, and 6.5 for setups B, C, and D, respectively, compared with setup A. The CTDI_vol increased up to 6 % using immobilization devices. Severe streak artifacts, provoked by the inflation valve of the mattresses were detected at the level of the head and shoulder. Applying immobilization devices for whole-body CT with automatic tube current modulation increases the radiation dose and decreases the quantitative image quality slightly. Severe artifacts, induced by the inflation valve of the mattress, can influence the diagnostic accuracy at the level of the head and shoulder.     

国产镍钛支架治疗恶性胆道梗阻的临床分析

目的:探讨经皮肝穿胆道植入国产镍钛支架治疗恶性梗阻性黄疸的价值和临床效果。方法:在X线监视下,22例恶性梗阻性黄疸患者经皮肝穿植入国产镍钛合金自膨式裸支架24枚,恶性梗阻的原因分别为胆管细胞癌8例,胰头癌6例,肝癌3例,壶腹癌2例,肝门转移性病变3例。结果:22例患者共24枚支架全部成功植入,术后21例患者症状缓解,总胆红素明显降低。1例患者术后1天出血死亡,30天生存率为95.5%.4个月和7个月后分别有3枚支架堵塞,通过支架内支架和钢丝疏导解除。结论:国产镍钛合金自膨式裸支架性能良好,临床疗效满意。     

TACE术后加压制动裤在预防术后出血和压疮中的应用

目的 探讨TACE术后加压制动裤在预防术后出血和压疮中的作用.方法 选取2015年5月至2016年5月行肝癌经股动脉穿刺介入治疗的50例患者作为研究对象,将患者随机分为观察组和对照组,每组各25例.观察组采用TACE术后穿加压制动裤并按TACE术后护理常规执行,对照组按TACE术后护理常规并予沙袋压迫穿刺点6h执行.观察两组患者穿刺点处局部淤血、血肿和假性动脉瘤指标的差异;观察两组患者的受压部位皮肤情况,有无皮肤潮湿感、灼热感、麻木感及发红情况.结果 观察组出血发生率为4％,明显低于对照组的出血发生率32％.两组患者均无压疮发生,但是皮肤潮湿及灼热感、麻木感、皮肤发红方面,观察组优于对照组(P＜0.05).结论 TACE术后加压制动裤有预防术后出血、压疮发生的作用.该裤设计合理,结构简单,穿脱方便,提高了患者的舒适度及满意度,值得推广使用.     

湿润烧伤膏治疗压迫性溃疡

目的:观察总结烧伤再生医学包扎疗法治疗压迫性溃疡的临床疗效与护理经验.方法:对我科收治的37例压迫性溃疡患者采用烧伤再生医学(MEBT/MEBO)包扎疗法治疗创面,并加强心理指导与翻身护理,观察记录创面愈合情况.结果:创面采用MEBO治疗7天～10天,创面坏死组织很快被MEBO液化清除,创面变得清洁,感染情况较快得到控制,肉芽和周围皮肤生长较侠,12周愈合率达到67.57%.结论:烧伤再生医学包扎疗法对压迫性溃疡创面有较好的抗感染能力和促进肉芽组织与皮肤组织再生的能力,治疗与护理方法简单、使用方便、疗效确切.     

Methodology of Continuous Extracranial Radiosurgery for Lung Cancer Using EXOMIO 3-D CT Simulation

BACKGROUND: It is well known that precision can be achieved using radiosurgery for brain tumors. This method can be extended to treat localized lung tumors and lung metastases. MATERIAL AND METHODS: The conventional procedure of extracranial radiosurgery is contained in the following steps: adaptation of the vacuum mattress, planning CT, three-dimensional (3-D) treatment planning, CT repositioning, and irradiation. In the new procedure of continuous extracranial radiosurgery, a short treatment planning is often used for simple target shapes (spherical, rotation-symmetrical), and the irradiation follows directly after the planning procedure. During continuous extracranial radiosurgery, the patient has to lie still in the body frame from the planning CT to irradiation. Fast treatment planning is performed by using multileafs and EXOMIO (Medintec, Bochum, Germany), a software for CT simulation. The high quality of the digitally reconstructed radiographs (DRRs) of each field enables a high precision in dose application by the comparison with the verification radiograph and the DRR (Elekta iView, Hamburg, Germany). RESULTS: In five lung cancer patients the average time for the complete procedure from planning CT to irradiation was 107 min (range: 91-124 min). The mean positioning accuracy of the patient in the vacuum bed (total shift) was 3.3 mm (range: 2.9-4.7 mm). CONCLUSION: Continuous extracranial radiosurgery can be performed for small peripheral lung tumors or metastases and is optimizing the conventional procedure. It is of special interest to clinics with restricted CT capacity.